New Era

This post is the first of the “New Era” of this website. I recently gave a talk at a gathering here in Ajijic outlining my plans for a new book, “Recovering in Chaos,” and a podcast of the same name. Below is the text of that talk in its entirety, making this a much longer post than usual. Sorry for that, but here are the reasons that I see for writing the book and doing the podcast.

Introduction

I wrote Powerless No Longer because I couldn’t not write it. I saw a need to do what I could to spread the word about cognitive recovery in an environment that at the time was overtly hostile to the idea that there might be a better way to approach addiction than the traditional 12-step modality. Today, most of that hostility has dissipated, at least in the professional community, primarily due to hundreds of studies done in the last five years demonstrating the efficacy of cognitive tools.

One result of this is the exponential growth of SMART Recovery, the leading self-help group using evidence-based methodologies. When I became involved with SMART in 2006, there were perhaps 200 meetings in the US and Canada, period. Today, the story is a little different. There are now 2,500 meetings on six continents, and over a hundred scientific peer reviewed papers on various aspects of the SMART program.

This growth is due to several factors, one of the important ones being the acceptance of cognitive methods in the battle against addiction by the professional community, but one of the primary drivers has been the surge in the need for recovery programs of all types due to the significant recent uptick in overdoses and addictive problems in general.

The tentative title of my new book and podcast is Recovering in Chaos. First I’ll explain why I chose the title, then I’m going to try and make the case that the exploding addiction and overdose problems in the US aren’t totally due to the factors we’re told they are. Lastly, I’ll talk about potential solutions, but unfortunately, I don’t have a lot of positive things to say about the possibilities.

Recovery

Recovering in chaos as a title is admittedly a little over the top. A bit of hyperbole to focus upon a point best explained by looking at the two words separately.

We hear the word “recovery” a lot in the context of addiction and other self-defeating behaviors, but few people consider what it actually means. The word has become something of a shorthand, a more delicate way of saying “I’m trying to quit drinking,” or “I’m getting over my nasty drug habit.” When asked to define the term, most addicts will say that they’re trying to quit the behavior, and regain their spouse, job, children, place in society, or whatever it is that they think the behavior might have cost them.

There’s really a better definition, though, one that reflects what the “recovering” person is really trying to accomplish, and it comes from an agency of the US government.

The Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services defines recovery simply as “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

Isn’t this exactly what addicts are trying to do, whether they realize it or not? Isn’t this the goal of all those self-help meetings, books like mine, therapists, rehab facilities, and yes, even the criminal justice system (although it’s somewhat misguided)? In fact, isn’t this what all of us are striving for? Even those of you who are not burdened with addictions are perhaps experiencing some self-defeating behavior or behaviors that are standing in the way of your living a truly self-directed life in a healthy manner, and reaching your full potential, are you not? After all, none of us would be human if we couldn’t improve in some area of our lives, isn’t that true?

Looking at recovery as a process with goals in at least three distinct high-level areas allows us to look at those areas with an eye towards creating more specific short and long-term goals tailored to the individual and their particular needs. That’s one of the things we do in cognitive recovery. Part of that planning process is identifying, quantifying, and resolving potential obstructions that could thwart or derail our change attempt.

Being able to see ways around those obstacles is a necessary component of the overall motivation for change. In other words, if an addict can’t see a viable path towards making their life better than it is currently, their chances of achieving success are greatly diminished, if not nonexistent. Change is hard, and an addict must have more than negative incentives to begin the process, they must be able to see the “light at the end of the tunnel,” but all too often today that light is an oncoming train.

Chaos

That brings me to the second word in the title, chaos. The dictionary definition of chaos as a noun is: “complete disorder and confusion,” and the outside environment we’re living in hasn’t quite reached that stage, has it? Yes, the political and economic situation is a bit, let’s say confusing right now, but it’s not total chaos, at least not yet or for most people. We tend to discount the effects of forces in our environment that don’t affect us directly, but consider the situation of the addict.

Those with addictive self-defeating behaviors tend to create their own chaos, their own disorder and confusion, which adds to that which they perceive from the outside world. The degree of chaos we all experience is entirely subjective, of course, and dependent upon our own situation.

There is another definition of chaos I would like to explore, the physics definition, which is: “the property of a complex system whose behavior is so unpredictable as to appear random, owing to great sensitivity to small changes in conditions.” That seems to me even a better explanation of what we see driving high levels of anxiety among all of us today, even those who don’t happen to suffer from addictive self-defeating behaviors. We are beset by seemingly random events which threaten our lives and property, as in the case of climate events; and our livelihoods, as in the state of the economy and the legal/political system. Not so much here, fortunately, but consider our children and friends still trying to make a living up north in the midst of an incredibly complex environment.

We live in an era of constant change, and it’s not the slow, gradual, linear change we evolved on the African Savannah to deal with either, and it’s a rate-of-change that’s an order of magnitude greater than that in which our generation grew up and spent most of our careers. The rate-of-change we are experiencing now is exponential in many areas, making it extremely difficult to predict our own futures, or sometimes even the consequences of our own actions, even within the short-term.

Recovery is hard enough even in the best of times, with relatively stable economic, political, and climate systems, and it’s even harder today when the overall environment is anything BUT stable. As I said before, our self-defeating behaviors create enough chaos all by themselves without the perception, true or false, that the rest of the world is falling apart.

Some Studies

Let’s talk about that “perception” for a moment. What is it that’s really going on here, and how is it affecting people. What do we know for sure?

We know that at least 64,000 Americans died from opioid overdoses last year, and that number may be up to 20% low. We know we’re on track to eclipse that number in 2017. In addition, 88,000 people died last year from alcohol-related causes, a number that’s also expected to increase. 1 in 10 deaths among working age adults are due to alcohol.

Two huge studies, one in 2002 and the other in 2013 tracked the drinking patterns of nearly 100,000 Americans, and found that overall incidents of alcohol use disorders rose almost 50% between the two studies. 8.5% of the population was affected during the first study, and 12.7% in the second. That’s almost 30 million Americans actively struggling with alcohol abuse, or 1 out of 8.

A couple of little side notes from that study are interesting. Alcohol use disorders nearly doubled among the African American population, and increased 84% among women. Those 45 to 65 showed an 82% increase. The highest increase between the two studies, however was in those 65 and over, with a staggering 106% increase.

There are some very disturbing trends in this new data, especially to those of us who have spent some time studying the problem. There have been hundreds of longitudinal, general population studies performed in the last 40 or 50 years aimed partially at determining the “normal course” of addiction to various substances. Two facts which emerged from these studies show that most addicts, 65 to 90%, quit on their own, and most before the age of 45; and the “harder the drug, the shorter the course of the addiction.

What we’re seeing in the last few years, however, no longer fits the model established for decades. The greatest increase in not only drug overdose deaths but also in the incidence of alcohol use disorder was among older Americans, those 45 years old and older! This is exactly the opposite of what the historical data typically showed.

I’m going to delve into one of those earlier studies, because I think we can learn a great deal from it as we try and figure out what’s happening today. So-called conventional wisdom tells us that heroin is a substance that addicts anyone who uses it instantly and for life. We hear that it’s virtually impossible to quit, at least without resorting to some sort of maintenance program involving another drug, like methadone. Quit heroin without help? Impossible, we’re told.

Opiates and other drugs were easily available in Vietnam, and large numbers of service personnel appeared to be using them on a regular basis. The Nixon administration set up a series of studies to estimate the size of the drug use problem, and plan for proper treatment facilities for returning addicted veterans. The studies looked at two samples of enlisted men who left Vietnam to return home in September of 1971. They chose one sample on a random basis from all returnees and the other from those who had screened “drug positive” before departure.

The studies determined that almost half of all enlisted men had used narcotics while in Vietnam, 34% had tried heroin, and 38% had tried opium. Almost half of those who had used narcotics had done so more than weekly for greater than 6 months. Overall, 20% of all returning men admitted to having been “addicted” to narcotics while in Vietnam. That is, they had felt “strung out,” and experienced repeated and prolonged withdrawal symptoms.

During the first year after return, about 10% of the general sample and one-third of those who had tested positive at departure proved to have used any narcotics. Only 7% in the drug-positive sample and 12% of all men who had been addicted in Vietnam were still addicted after returning.

Following the veterans for another two years, fewer than 20% of those who were addicted in Vietnam had resumed regular narcotic use. Only 2% of those who had used narcotics in Vietnam, and 6% of those in the “drug-positive” sample ever attended drug-abuse treatment, therefore treatment had little to do with the remarkable recovery rates.

A 25-year follow-up conducted with the remaining members of the original study group showed that most attempted to quit and the majority succeeded without the aid of traditional drug treatment programs. Although only 8% of the overall sample were treated in a formal treatment setting, recovery rates exceeded 80%

The overwhelming majority of heroin users who returned from Vietnam with a problem solved it by themselves, without treatment facilities or self-help programs. They found the power within themselves and quit on their own, and at astounding rates.

Undoubtedly, a great deal of the success these men experienced had to do with the abrupt change in environment upon their return home. In Vietnam, they were inundated with the stress of war, and their fellow soldiers were likely heroin users. Their environments had multiple triggers driving them toward drug use.

At home, however, they were free from the stresses and triggers that drove their behaviors. Most of them were beginning new lives, establishing families, starting school, activities where a drug habit would be a serious impediment. In other words, with little to gain from continued drug use, and much to lose from it, their decision to quit became almost a no-brainer.

The Vietnam study gives us valuable insight into the behavioral nature of addiction vs. the addictive aspects of the drugs themselves. Obviously, elimination of stress, re-connection with family and friends, and focusing upon the future played a major role in the lives of the of addicted veterans who successfully recovered. In other words, whether or not addicts quit using drugs has a great deal to do with their alternatives, and not so much the characteristics of the drugs themselves.

In 2001, in an effort to address its own pervasive drug problem, Portugal decriminalized all drugs, and shifted drug control policy from the Justice Department to the Ministry of Health. 16 years later, they enjoy the second lowest drug overdose rate in the EU, and addiction rates have plummeted. Since addicts who are caught with small quantities of drugs don’t end up with criminal records, they can remain in the normal workforce rather than facing a lifetime of marginal employment on the fringes of society. As a result, their recovery rates are some of the highest in the world.

I mention it because Portugal accomplished through drug policy the same things that leaving Vietnam did for the returning veterans – they changed the environment. By removing the criminality, they restored the hope of a better outcome to their addicted population.

We are told that the reasons for the current drug overdose crisis are fairly simple: over prescription of opioids for pain, and ready availability of all manner of opioid forms and derivatives as well as synthetic substitutes. We blame the Mexican drug cartels (although 90% of the world’s opium poppy is grown in Afghanistan), our porous borders and especially the aggressive, predatory marketing practices of the profiteering pharmaceutical industry. Our response is to double-down on the failed war on drugs, make it more difficult for physicians to dispense pain meds, and build more prisons.

I have no doubt that thanks to those “marketing” efforts by big pharma, there are a huge number of people who become addicted to pain medication and graduate to cheaper, more easily available substitutes that they eventually misuse. That simple explanation doesn’t even begin to account for the age ranges of the overdose victims, nor does it even attempt to address exploding alcohol use. From young to old, we are seeing the magnitude of our substance abuse problem increase exponentially, in spite of the publicity it’s now receiving.

The approach that the US government has taken hasn’t varied at all since the formation of the Federal Bureau of Narcotics in 1930. Interdiction of supply and criminalization of use and distribution have been the principal tools. One of results has been to make us a nation with 25% of the world’s prisoners in spite of only having 5% of the world’s population.

The government has funded some treatment efforts, and there are programs in most prisons, but they aren’t having much of an effect on the problem. The reason they’re not too effective, in my opinion, is that they’re still using a top-down approach to mitigating the symptoms, rather than addressing the core of the problem itself. The government can’t really address the core of the problem because in many ways, it IS the problem.

Forming Self-Defeating Behaviors

To understand why this is so, we have to take a quick look at why people become addicted to substances and behaviors in the first place. The reasons behind why people begin using substances or indulging in behaviors that later become self-defeating aren’t really all that complicated. We learn self-defeating behaviors because at some point they worked for us, it’s really that simple.

In the very beginning, we may start using drugs and/or alcohol to gain acceptance from our peer group, we use them to overcome social anxiety and feel normal. Perhaps we began using because it was fun, we enjoyed the buzz and how it made us feel. Some use substances to medicate other conditions like depression; some to relieve physical or emotional pain; then there’s always the relief of stress, perhaps the number one reason. Whatever the reason we start, it works for us at the beginning, and that’s why we start forming habits based around the drugs we use.

Later on, if we use long enough, we become dependent upon the substance. Even after a period of abstinence, environmental cues or stressors can trigger drug use, hijacking our basic survival instincts, and triggering responses over which we seem to have little control. Social concerns lose their meaning, no matter how pressing they are. We have learned we must have the drug, no matter what the cost, even to those we hold dear because we believe our basic survival is at stake. Family, job, possessions, and even personal safety are unimportant now. The drug is what matters.

That’s an overview of the progression that leads to substance use disorders, and can, of course lead to overdoses of whatever substance the addict is using, including, by the way, alcohol. Now, let’s focus upon the environment in which we’re living, and by that I mean all of the potential stressors, economics, politics, international relations, etc., not just the physical environment.

Today’s Environment

There are many relevant aspects of the environment today, but I’m going to zero-in on just a few that I think have a major influence upon the problem we’re discussing. I’ll try to stick to facts that are beyond dispute, regardless of anyone’s worldview, but whether or not some of these are true, they are certainly widely-held perceptions, which for most of the US population are interchangeable with facts.

Most sources agree that the labor force participation rate is at historic lows. Much of the decrease over the last ten years or so is in the 18 to 34 year-old age group, more of whom live with their parents than live independently. We have an economy that generates mostly part-time jobs with no benefits, that don’t pay enough for younger Americans to start a family or even to make minimum payments on their record college loans. It’s not only the manufacturing jobs of the middle class that have been off shored, but also professional skill jobs such as software engineering, design, accounting, and IT have vanished.

A great many of those part-time jobs are being taken by those 55 and older, the most rapidly-growing segment in labor force participation. Thanks to Fed’s zero-interest rate policy, the retirement savings (when they exist) of most Americans produces no income, forcing them into the labor market in large numbers. I don’t know about any of you, but if I had to live in America, I would still be either teaching computer science or consulting to make ends meet.

The United States is perhaps the first country ever to reverse the development process and go backwards, giving up industry, manufacturing, and tradable professional skill jobs and replacing them with lowly paid, part-time service jobs. Many Americans feel powerless in the face of a government that doesn’t listen to them, and an economy that works only for the few at the expense of the many.

In my opinion, these pervasive perceptions, especially among the poor and middle-class, are playing a large part in the epidemic of substance abuse we’re experiencing, and the difficulty people are having beginning, and staying with recovery.

Solutions?

There are three ways to approach the problem, you can change the reality, change the perception, or modify individual expectations.

We could have a long discussion about changing the reality, and it might become rather heated. The last thing I want to get into here is a clash of worldviews. There is very little evidence that voting, the primary means we have at our disposal to change the system, changes anything. You vote against war, you get more war. You vote to bring jobs back, and the jobs you get are part-time with no benefits. You vote against inequality, you get wealth transfer at higher rates. We could go on forever, but it would serve no purpose. There are some feasible ways to change the reality, as Portugal has shown, but I have seen neither the political will nor frankly the interest on the part of the government to reign-in predatory practices by Pharma, or implement any other solutions that might have a chance of working.

Portugal actually did more than simply decriminalize drug possession, they took an active role in helping recovering individuals assimilate into society. I’m not even sure that could be accomplished in a country like the US where the size of the population troubled by alcohol and other drugs is 5 to 6 times the total population of Portugal.

It would take a massive public outcry to change the reality, but those have been few and far between in the last few decades. Over 400 people a day are dying from preventable causes involving alcohol and other drugs, that’s a 9/11 every 9 days or so, but there’s too much profit to be made in keeping the status quo, and too much profit to lose in making any changes in policy.

Changing the perception is only slightly more realistic. For the last year at least, media outlets in the US have been doing the best they can to promote their own particular worldviews, or that of the prevailing special interests they’re beholden to, including the government itself. All they have succeeded in doing is to thoroughly muddle the situation, further dividing the country, and leaving most Americans confused, bewildered, and unsure of the future. It’s very difficult to get a person to believe they can have a wonderful future, and be anything they want to be when they have a criminal record, an incomplete or useless (although expensive) education, a mountain of debt, and few prospects.

That leaves the third option, working with the individual, and changing expectations, which makes sense because recovery from any self-defeating behavior is an individual thing. What works for me might not work for you, and vice-versa. There are as many paths to recovery as there are people who have successfully recovered, and the best we can do is help individuals discover the path that will work for them.

There are several cognitive recovery tools that lend themselves to the problems addicts face in today’s new reality, and I will cover them in the book, on the podcast, and in future posts. You might be wondering what you can do, if indeed you wanted to do something. I put it that way because there are many different situations in the world today that cry out for our attention, this being only one. Well, there IS something you can do, especially if you have someone in your life, or someone you know with this type of problem.

Johan Hari, in his excellent TED talk a couple of years ago made the point that “the opposite of addiction isn’t sobriety, the opposite of addiction is connection.” His point has been proven many times over, from the Vietnam study to the present. The worst thing you can do to an addict in your life is to cut them off, or threaten their connection with you as a way to try and get them to do what you want them to do. Addicts can be the most frustrating people in the world, I can tell you from personal experience, but to cut them off is, as Johan says, “to import the logic of the drug war into private lives.” That logic doesn’t work on a national scale, and it won’t work at the family level either.

The thing we should do is encourage connection. Encourage activities that give the addict an alternative to the using lifestyle. Tell them they’re not alone, that you care about them, and will be there when and if they need you. If there IS a way to change our current reality, it’s going to involve love, caring, and sharing, rather than the intolerance and hatred we seem to be wallowing in today.